Clinical efficacy of arthroscopic simultaneous treatment for anterior cruciate ligament injury combined with meniscus bucket-handle tear_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANG Xuezhen ¹ , TIAN Yuan ² ,  WANG Shaoshan ³ , ZHENG Yueyue ²

1. Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250355, P.R.China;
2. Operation Room, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250011, P.R.China;
3. Department of Orthopedics, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250011, P.R.China;

Corresponding author：

WANG Shaoshan, Email: shaoshan278@sohu.com

Keywords：

Arthroscopy; anterior cruciate ligament; meniscus; bucket-handle tear; ligament reconstruction

DOI：

10.7507/1002-1892.201612066

Video：

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Objective To explore the clinical efficacy of arthroscopic simultaneous both anterior cruciate ligament (ACL) reconstruction and suture of the meniscus bucket-handle tear (BHT). Methods Between January 2013 and April 2014, 22 patients (22 knees) with ACL injury and BHT, who accorded with the inclusion criteria, were studied. There were 14 males and 8 females with a mean age of 30.68 years (range, 15-44 years). The left side was involved in 10 cases and the right side in 12 cases. Injury located at the medial meniscus in 14 patients, and at the lateral meniscus in 8 patients. The median of interval from injury to operation was 40 days (range, 9 hours to 4 years). BHT was sutured, and then single bundle reconstruction of ACL was performed under arthroscopy. Results All incisions healed by first intention, and there were no serious complications such as infection, vascular injury, and nerve injury. The patients were followed up for 26.7 months on average (range, 12-42 months). At 6 weeks after operation, one patient had limited motion of the knee, the function was recovered after release under anesthesia; and one patient had joint space tenderness, which was relieved after conservative treatment. The total effective rate was 90.9% (20/22). At last follow-up, the anterior drawer test, Lachman test, and McMurray test were negative in all the cases. The visual analogue scale (VAS), Tegner activity level score, and Lysholm score were significantly improved at 12 months after operation when compared with preoperative scores (P<0.05). At 6-12 months after operation, complete healing was obtained in 7 cases, and partial healing in 11 cases, and nonunion in 4 cases based on MRI evaluation criteria by Crueset al. There was no rupture of reconstruc-tive ligament during follow-up. Conclusion Arthroscopic simultaneous both ACL reconstruction and suture of BHT can improve the symptoms, reduce the risk of re-tear of sutured meniscus effectively, delay degeneration of articular cartilage, and maintain the stability of the knee joint.

Citation： LIANG Xuezhen, TIAN Yuan, WANG Shaoshan, ZHENG Yueyue. Clinical efficacy of arthroscopic simultaneous treatment for anterior cruciate ligament injury combined with meniscus bucket-handle tear. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(5): 547-552. doi: 10.7507/1002-1892.201612066 Copy

1.	Kluczynski MA, Marzo JM, Bisson LJ. Factors associated with meniscal tears and chondral lesions in patients undergoing anterior cruciate ligament reconstruction: a prospective study. Am J Sports Med, 2013, 41(12): 2759-2765.
2.	Anderson AF, Irrgang JJ, Dunn W, et al. Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med, 2011, 39(5): 926-932.
3.	Lim HC, Bae JH, Kim TS, et al. Intra-articular patterns of bucket handle meniscal tears and its relation to reducibility. Clin Orthop Surg, 2012, 4(2): 129-133.
4.	Yoon KH, Park KH. Meniscal repair. Knee Surg Relat Res, 2014, 26(2): 68-76.
5.	张元民, 王国栋, 赵晓伟, 等. 不同半月板修复方式与半月板部分切除术后胫股关节的接触力学研究. 实用医学杂志, 2014, 30(18): 2915-2918.
6.	冯华, 姜春岩. 实用骨科运动损伤临床诊断. 2 版. 北京: 人民军医出版社, 2012: 42-50.
7.	Crues JV 3rd, Mink J, Levy TL, et al. Meniscal tears of the knee: accuracy of MR imaging. Radiology, 1987, 164(2): 445-448.
8.	Tucciarone A, Godente L, Fabbrini R, et al. Meniscal tear repaired with Fast-Fix sutures: clinical results in stable versus ACL-deficient knees. Arch Orthop Trauma Surg, 2012, 132(3): 349-356.
9.	Cox CL, Huston LJ, Dunn WR, et al. Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med, 2014, 42(5): 1058-1067.
10.	冯华, 张辉, 郭铁能, 等. 膝关节前十字韧带切断对内侧半月板后角应力的影响. 中华骨科杂志, 2006, 26(7): 476-478.
11.	Feucht MJ, Bigdon S, Bode G, et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res, 2015, 10: 34.
12.	Dürselen L, Vögele S, Seitz AM, et al. Anterior knee laxity increases gapping of posterior horn medial meniscal tears. Am J Sports Med, 2011, 39(8): 1749-1755.
13.	王江涛, 刘玉杰, 曲峰, 等. 前交叉韧带合并半月板损伤同期修复 139 例随访报告. 中国骨与关节杂志, 2015, 14(11): 861-864.
14.	李梦远, 徐雁, 龚熹, 等. 膝关节前交叉韧带断裂合并半月板桶柄样撕裂的临床治疗研究. 中国运动医学杂志, 2014, 33(5): 385-390.
15.	Krych AJ, Pitts RT, Dajani KA, et al. Surgical repair of meniscal tears with concomitant anterior cruciate ligament reconstruction in patients 18 years and younger. Am J Sports Med, 2010, 38(5): 976-982.
16.	谷绍芳, 陈游. 前交叉韧带断裂合并半月板损伤的关节镜手术治疗. 中国现代手术学杂志, 2009, 13(2): 108-110.
17.	闫金明. 关节镜下修复重建前交叉韧带合并半月板损伤的临床效果分析. 中国内镜杂志, 2016, 22(9): 102-104.
18.	解新刚, 杨惠光, 姜雪锋, 等. 关节镜下联合修补技术治疗内侧半月板桶柄样撕裂. 交通医学, 2009, 23(4): 344-346.
19.	Melton JT, Murray JR, Karim A, et al. Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study. Knee Surg Sports Traumatol Arthrosc, 2011, 19(10): 1729-1734.
20.	O’Shea JJ, Shelbourne KD. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. Am J Sports Med, 2003, 31(2): 216-220.
21.	袁帅, 祝云利, 吴宇黎, 等. 关节镜下内侧半月板桶柄样撕裂联合缝合 23 例报告. 中国骨与关节杂志, 2015, 4(4): 256-260.
22.	Pierre A, Hulet C, Locker B, et al. Outcome of 95 stable meniscal tears left in place after reconstruction of the anterior cruciate ligament. Rev Chir Orthop Reparatrice Appar Mot, 2001, 87(7): 661-668.
23.	White LM, Schweitzer ME, Weishaupt D, et al. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Radiology, 2002, 222(2): 421-429.
24.	郑卓肇, 余家阔, 尚瑶, 等. 半月板缝合术后: MRI 诊断的价值. 临床放射学杂志, 2009, 28(1): 81-83.
25.	Sanders TG, Miller MD. A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the knee. Am J Sports Med, 2005, 33(1): 131-148.
26.	Toms AP, White LM, Marshall TJ, et al. Imaging the post-operative meniscus. Eur J Radiol, 2005, 54(2): 189-198.
27.	Hantes ME, Zachos VC, Zibis AH, et al. Evaluation of meniscal repair with serial magnetic resonance imaging: a comparative study between conventional MRI and indirect MR arthrography. Eur J Radiol, 2004, 50(3): 231-237.

1. Kluczynski MA, Marzo JM, Bisson LJ. Factors associated with meniscal tears and chondral lesions in patients undergoing anterior cruciate ligament reconstruction: a prospective study. Am J Sports Med, 2013, 41(12): 2759-2765.
2. Anderson AF, Irrgang JJ, Dunn W, et al. Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med, 2011, 39(5): 926-932.
3. Lim HC, Bae JH, Kim TS, et al. Intra-articular patterns of bucket handle meniscal tears and its relation to reducibility. Clin Orthop Surg, 2012, 4(2): 129-133.
4. Yoon KH, Park KH. Meniscal repair. Knee Surg Relat Res, 2014, 26(2): 68-76.
5. 张元民, 王国栋, 赵晓伟, 等. 不同半月板修复方式与半月板部分切除术后胫股关节的接触力学研究. 实用医学杂志, 2014, 30(18): 2915-2918.
6. 冯华, 姜春岩. 实用骨科运动损伤临床诊断. 2 版. 北京: 人民军医出版社, 2012: 42-50.
7. Crues JV 3rd, Mink J, Levy TL, et al. Meniscal tears of the knee: accuracy of MR imaging. Radiology, 1987, 164(2): 445-448.
8. Tucciarone A, Godente L, Fabbrini R, et al. Meniscal tear repaired with Fast-Fix sutures: clinical results in stable versus ACL-deficient knees. Arch Orthop Trauma Surg, 2012, 132(3): 349-356.
9. Cox CL, Huston LJ, Dunn WR, et al. Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med, 2014, 42(5): 1058-1067.
10. 冯华, 张辉, 郭铁能, 等. 膝关节前十字韧带切断对内侧半月板后角应力的影响. 中华骨科杂志, 2006, 26(7): 476-478.
11. Feucht MJ, Bigdon S, Bode G, et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res, 2015, 10: 34.
12. Dürselen L, Vögele S, Seitz AM, et al. Anterior knee laxity increases gapping of posterior horn medial meniscal tears. Am J Sports Med, 2011, 39(8): 1749-1755.
13. 王江涛, 刘玉杰, 曲峰, 等. 前交叉韧带合并半月板损伤同期修复 139 例随访报告. 中国骨与关节杂志, 2015, 14(11): 861-864.
14. 李梦远, 徐雁, 龚熹, 等. 膝关节前交叉韧带断裂合并半月板桶柄样撕裂的临床治疗研究. 中国运动医学杂志, 2014, 33(5): 385-390.
15. Krych AJ, Pitts RT, Dajani KA, et al. Surgical repair of meniscal tears with concomitant anterior cruciate ligament reconstruction in patients 18 years and younger. Am J Sports Med, 2010, 38(5): 976-982.
16. 谷绍芳, 陈游. 前交叉韧带断裂合并半月板损伤的关节镜手术治疗. 中国现代手术学杂志, 2009, 13(2): 108-110.
17. 闫金明. 关节镜下修复重建前交叉韧带合并半月板损伤的临床效果分析. 中国内镜杂志, 2016, 22(9): 102-104.
18. 解新刚, 杨惠光, 姜雪锋, 等. 关节镜下联合修补技术治疗内侧半月板桶柄样撕裂. 交通医学, 2009, 23(4): 344-346.
19. Melton JT, Murray JR, Karim A, et al. Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study. Knee Surg Sports Traumatol Arthrosc, 2011, 19(10): 1729-1734.
20. O’Shea JJ, Shelbourne KD. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. Am J Sports Med, 2003, 31(2): 216-220.
21. 袁帅, 祝云利, 吴宇黎, 等. 关节镜下内侧半月板桶柄样撕裂联合缝合 23 例报告. 中国骨与关节杂志, 2015, 4(4): 256-260.
22. Pierre A, Hulet C, Locker B, et al. Outcome of 95 stable meniscal tears left in place after reconstruction of the anterior cruciate ligament. Rev Chir Orthop Reparatrice Appar Mot, 2001, 87(7): 661-668.
23. White LM, Schweitzer ME, Weishaupt D, et al. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Radiology, 2002, 222(2): 421-429.
24. 郑卓肇, 余家阔, 尚瑶, 等. 半月板缝合术后: MRI 诊断的价值. 临床放射学杂志, 2009, 28(1): 81-83.
25. Sanders TG, Miller MD. A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the knee. Am J Sports Med, 2005, 33(1): 131-148.
26. Toms AP, White LM, Marshall TJ, et al. Imaging the post-operative meniscus. Eur J Radiol, 2005, 54(2): 189-198.
27. Hantes ME, Zachos VC, Zibis AH, et al. Evaluation of meniscal repair with serial magnetic resonance imaging: a comparative study between conventional MRI and indirect MR arthrography. Eur J Radiol, 2004, 50(3): 231-237.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical efficacy of arthroscopic simultaneous treatment for anterior cruciate ligament injury combined with meniscus bucket-handle tear

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